Christopher C Winchester1, Tatiana V Macfarlane2, Mike Thomas2, David Price2. 1. Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen, UK. Electronic address: c.winchester@abdn.ac.uk. 2. Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen, UK.
Abstract
BACKGROUND: Lower respiratory tract infection (LRTI) is common in the community and may result in hospitalization or death. This observational study aimed to investigate the role of antibiotics in the management of LRTI in the primary care setting in the United Kingdom. METHODS: Patients receiving a first diagnosis of LRTI during 2004 and satisfying inclusion and data quality criteria were identified in the General Practice Research Database. Factors associated with respiratory infection-related hospital admissions and death in the 3 months following the initial diagnosis were identified using Cox proportional hazards regression. RESULTS: Antibiotic prescribing on the day of diagnosis was associated with a decreased rate of respiratory infection-related hospital admission (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.58 to 0.92), while antibiotic prescribing in the previous 7 days (HR, 1.92; 95% CI, 1.24 to 2.96) and prior referral or hospitalization (HR, 1.48; 95% CI, 1.20 to 1.83) were associated with an increased risk of hospital admission. Female sex (HR, 0.73; 95% CI, 0.64 to 0.84), allergic rhinitis (HR, 0.48; 95% CI, 0.27 to 0.83), influenza vaccination (HR, 0.75; 95% CI, 0.65 to 0.87), prior inhaled corticosteroid use (HR, 0.63; 95% CI, 0.52 to 0.76), and antibiotic prescription on the day of diagnosis (HR, 0.31; 95% CI, 0.26 to 0.37) were associated with decreased respiratory infection-related mortality, while a Charlson comorbidity index of >or= 2 (HR, 2.24; 95% CI, 1.72 to 2.92), antibiotic prescription in the previous 7 days (HR, 1.56; 95% CI, 1.20 to 2.03), and frequent consultation (HR, 1.62; 95% CI, 1.09 to 2.40) were associated with increased mortality. CONCLUSIONS: Antibiotic prescribing on the day of LRTI diagnosis was associated with reductions in hospital admissions and mortality related to respiratory infection. Antibiotics may help to prevent adverse outcomes for some patients with LRTI.
BACKGROUND: Lower respiratory tract infection (LRTI) is common in the community and may result in hospitalization or death. This observational study aimed to investigate the role of antibiotics in the management of LRTI in the primary care setting in the United Kingdom. METHODS:Patients receiving a first diagnosis of LRTI during 2004 and satisfying inclusion and data quality criteria were identified in the General Practice Research Database. Factors associated with respiratory infection-related hospital admissions and death in the 3 months following the initial diagnosis were identified using Cox proportional hazards regression. RESULTS: Antibiotic prescribing on the day of diagnosis was associated with a decreased rate of respiratory infection-related hospital admission (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.58 to 0.92), while antibiotic prescribing in the previous 7 days (HR, 1.92; 95% CI, 1.24 to 2.96) and prior referral or hospitalization (HR, 1.48; 95% CI, 1.20 to 1.83) were associated with an increased risk of hospital admission. Female sex (HR, 0.73; 95% CI, 0.64 to 0.84), allergic rhinitis (HR, 0.48; 95% CI, 0.27 to 0.83), influenza vaccination (HR, 0.75; 95% CI, 0.65 to 0.87), prior inhaled corticosteroid use (HR, 0.63; 95% CI, 0.52 to 0.76), and antibiotic prescription on the day of diagnosis (HR, 0.31; 95% CI, 0.26 to 0.37) were associated with decreased respiratory infection-related mortality, while a Charlson comorbidity index of >or= 2 (HR, 2.24; 95% CI, 1.72 to 2.92), antibiotic prescription in the previous 7 days (HR, 1.56; 95% CI, 1.20 to 2.03), and frequent consultation (HR, 1.62; 95% CI, 1.09 to 2.40) were associated with increased mortality. CONCLUSIONS: Antibiotic prescribing on the day of LRTI diagnosis was associated with reductions in hospital admissions and mortality related to respiratory infection. Antibiotics may help to prevent adverse outcomes for some patients with LRTI.
Authors: Kevin T Shiley; Gregory Nadolski; Timothy Mickus; Neil O Fishman; Ebbing Lautenbach Journal: Infect Control Hosp Epidemiol Date: 2010-07 Impact factor: 3.254
Authors: Martin Gulliford; Radoslav Latinovic; Judith Charlton; Paul Little; Tjeerd van Staa; Mark Ashworth Journal: J Public Health (Oxf) Date: 2009-09-04 Impact factor: 2.341
Authors: Patricia M Hordijk; Berna D L Broekhuizen; Chris C Butler; Samuel Coenen; Maciek Godycki-Cwirko; Herman Goossens; Kerry Hood; Richard Smith; Saskia F van Vugt; Paul Little; Theo J M Verheij Journal: Fam Pract Date: 2014-11-18 Impact factor: 2.267
Authors: Gurli Baer; Philipp Baumann; Michael Buettcher; Ulrich Heininger; Gerald Berthet; Juliane Schäfer; Heiner C Bucher; Daniel Trachsel; Jacques Schneider; Muriel Gambon; Diana Reppucci; Jessica M Bonhoeffer; Jody Stähelin-Massik; Philipp Schuetz; Beat Mueller; Gabor Szinnai; Urs B Schaad; Jan Bonhoeffer Journal: PLoS One Date: 2013-08-06 Impact factor: 3.240
Authors: Elizabeth R C Millett; Bianca L De Stavola; Jennifer K Quint; Liam Smeeth; Sara L Thomas Journal: BMJ Open Date: 2015-12-01 Impact factor: 2.692
Authors: Thomas Hone; Timothy Powell-Jackson; Leonor Maria Pacheco Santos; Ricardo de Sousa Soares; Felipe Proenço de Oliveira; Mauro Niskier Sanchez; Matthew Harris; Felipe de Oliveira de Souza Santos; Christopher Millett Journal: BMC Health Serv Res Date: 2020-09-15 Impact factor: 2.655